Non-drug perioperative interventions to reduce postoperative pulmonary complications after abdominal surgery: systematic review and meta-analysis.
Summary
This large systematic review and meta-analysis (255 RCTs; 55,260 participants) synthesized evidence on non-pharmacologic perioperative strategies to prevent PPCs after abdominal surgery. Overall PPC incidence was 11.7% across trials, and high-certainty evidence supported low inspired oxygen fraction (FiO2) strategies. The study establishes an evidence hierarchy to guide PPC prevention in practice.
Key Findings
- Synthesized 255 randomized trials (55,260 participants) assessing 10 intervention types (39 subtypes) for PPC prevention after abdominal surgery.
- Observed overall PPC incidence of 11.7% (6,467/55,260) across trials.
- High-certainty evidence supported the use of low inspired oxygen fraction (FiO2) strategies; an evidence hierarchy for PPC prevention was established.
Clinical Implications
Perioperative teams should incorporate evidence-backed non-pharmacologic strategies—particularly low FiO2 approaches—into abdominal surgery pathways to reduce PPCs. The results can refine ERAS and anesthesia protocols.
Why It Matters
Defines evidence-based, widely applicable perioperative strategies to reduce PPCs, a major source of morbidity and cost. High-quality synthesis in a top general medical journal is likely to inform guidelines.
Limitations
- Abstract truncation limits detail on effect sizes for specific interventions beyond low FiO2.
- Heterogeneity across interventions and perioperative practices may limit direct comparability.
Future Directions
Quantify comparative effectiveness of top-ranked strategies in head-to-head RCTs and evaluate implementation pathways within ERAS bundles to optimize PPC reduction.
Study Information
- Study Type
- Systematic Review/Meta-analysis
- Research Domain
- Prevention
- Evidence Level
- I - Systematic review and meta-analysis of randomized controlled trials with bias and certainty assessments.
- Study Design
- OTHER